Impact of COVID-19 on care-home mortality and life expectancy in Scotland

Abstract

Background: COVID-19 deaths are commoner among care-home residents, but the mortality burden has not been quantified.

Methods: Care-home residency was identified via a national primary care registration database linked to mortality data. Life expectancy was estimated using Makeham-Gompertz models to (i) describe yearly life expectancy from November 2015 to October 2020 (ii) compare life expectancy (during 2016-18) between care-home residents and the wider population and (iii) apply care-home life expectancy estimates to COVID-19 death counts to estimate years of life lost (YLL).

Results: Among care-home residents, life expectancy in 2015/16 to 2019/20 ranged from 2.7 to 2.3 years for women and 2.3 to 1.8 years for men. Age-sex-specific life expectancy in 2016-18 in care-home residents was lower than in the Scottish population (10 and 2.5 years in those aged 70 and 90, respectively). Applying care home-specific life expectancies to COVID-19 deaths yield mean YLLs for care-home residents of 2.6 and 2.2 for women and men, respectively. In total YLL care-home residents have lost 3,560 years in women and 2,046 years in men. Approximately half of deaths and a quarter of YLL attributed to COVID-19 were accounted for by the 5% of over-70s who were care-home residents.

Conclusion: COVID-19 infection has led to the loss of substantial years of life in care-home residents aged 70 years and over in Scotland. Prioritising the 5% of older adults who are care-home residents for vaccination is justified not only in terms of total deaths, but also in terms of YLL.

Keywords: COVID-19; care home; life expectancy; mortality; older people; vaccination.

Figure 1

Age- and sex-specific life expectancy estimates for care-home residents with uncertainty intervals, 2015/16–19/20. Shaded area denotes the age and sex distribution of the care-home population in 2017 (to retain clarity in the figure and since absolute values of probability densities are not easily interpretable without further calculation; no secondary axis is shown).

Figure 2

Sex-specific mortality by cause in care-home residents, October 2015 to November 2020. Dotted line indicates deaths with COVID-19 as the underlying cause that are a subset of respiratory deaths. All other causes are mutually exclusive.

Figure 3

Age- and sex-specific life expectancy in care-home residents compared with the age- and sex-specific general Scottish population, 2016–18. Shaded area denotes the age and sex distribution of the care-home population in 2017 (to retain clarity in the figure and since absolute values of probability densities are not easily interpretable without further calculation; no secondary axis is shown). Calendar-year data were used here rather than 12 months, which maximised the months spent within the pandemic in order to allow comparison between the care-home residents life expectancy estimates and that obtained from the NRS life tables.